Surgery and Surgical Subspecialties for the Family Doctor
Core concepts
Emphasis is on recognising surgical emergencies, appropriate referral, and postoperative care: acute abdomen, appendicitis, cholecystitis, bowel obstruction, hernia complications, and wound management. Also know common outpatient surgical problems (piles, abscesses, lumps) and when to refer urgently.
Question traps
- Acute abdomen red flags. Rigidity, guarding, rebound tenderness, absent bowel sounds, and haemodynamic instability mandate urgent surgical referral, not outpatient workup.
- Appendicitis migration. Periumbilical pain migrating to the right iliac fossa is classic; atypical presentations occur in pregnancy, the elderly, and children.
- Bowel obstruction. Colicky pain, vomiting, distension, and absolute constipation; the key distinguishing feature from ileus is the presence of colic and absence of flatus/stool.
- Hernia. A hernia that is irreducible and tender (strangulation) is a surgical emergency; a reducible, non-tender hernia can be referred electively.
- Wound care. Distinguish clean, clean-contaminated, contaminated, and dirty wounds; the decision to close primarily versus heal by secondary intention depends on contamination and time since injury.
Worked rule of thumb
Use the "sick or not sick" filter. If the patient has signs of peritonitis, shock, or sepsis, the answer is resuscitation and urgent surgical referral. If the patient is stable with a focal, benign examination, the answer is usually investigation or outpatient referral.
Postoperative care
Know the timing of common complications: haemorrhage (early), infection (days 3–7), dehiscence (days 5–10), and VTE (any time).